Syphilis: photos, symptoms and treatment
- Causative agent of syphilis
- Ways of Transmission
- Syphilis Classification
- Symptoms of syphilis
- Congenital syphilis
- Diagnosis of syphilis
- Syphilis treatment
- Syphilis prevention
Syphilis is a chronic venereal disease that has challenged humanity for centuries. It is prone to systemic flow and provokes the development of specific inflammation foci on the skin, mucous membranes and internal organs, and also affects the human bone and joint system.
This disease is common almost everywhere. Even before the 1980s, there was a decrease in the incidence of syphilis in the world, but by the 1990s, its rates began to grow. Today, according to world statistics, there are about 50 million people suffering from this severe illness.
At the beginning of the last century, syphilis was considered to be a male disease. Now, the main culprits in the spread of venous disease are women who are illegible in the choice of sexual partner and do not use personal protective equipment. It should be noted that today most often syphilis is detected in the layers of society with a low sexual culture.
Causative agent of syphilis
The causative agent of the disease is pale treponema. The name “pale” bacterium got its name due to poor staining with basic dyes. It is an active mobile pathogenic gram-negative microorganism of the spiral form with a thin curved body, moving around its own longitudinal axis. It was first discovered in 1905 by Hoffmann and Shaoudin. Pale treponema can develop only in a vacuum, i.e. is an obligate anaerob.
To date, there are three main subspecies of treponema:
- The classic pathogen of syphilis (treponema pallidum);
- Causative agent of endemic syphilis (treponema pallidum endemicum);
- The causative agent of tropical granuloma - non-venereal syphilis - (treponema pallidum pertenue).
Treponema pallidum belongs to the spirochete order. In length, it reaches 4-14 microns, in diameter - 02-05 microns. The body of this unique bacterium is covered with a mucopolysaccharide substance, which complicates the access of antibodies and phagocytes of the host.
In living form, pale treponema can be detected by microscopic examination of infected material.
According to experts, the causative agent of syphilis is undergoing a stage of intracellular development. After the death of the cell, a lot of treponema come out into the extracellular space and infect the neighboring cells of their host.
на искусственных питательных средах данный род бактерий практически не растет, а также быстро погибает вне человеческого организма. Note: on artificial nutrient media, this kind of bacteria practically does not grow, and also quickly dies outside the human body. However, in the cold, their vitality lasts a little longer.
Ways of transmitting syphilis
The main mode of transmission of the disease is sexual. However, by direct contact with a patient in an acutely infectious form, it is possible that a non-sexual (domestic) infection, as well as infection, can occur through household items contaminated with saliva, pus or other secretions in which the pathogen is located. Fortunately, at the moment the probability of occurrence of domestic syphilis is negligible. This form of the disease can still be found in developing countries with a very low level of sanitary and hygienic skills of the population. As a rule, young children suffer from household syphilis.
In the case when a pregnant woman becomes infected with syphilis, fetal infection occurs due to transplacental penetration of the pathogen. This often ends with congenital syphilis or the death of an unborn child.
Syphilis is of two types: congenital and acquired. Further, in accordance with the symptoms, classified:
- Primary syphilis (syphilis i primaria);
- Secondary fresh syphilis (syphilis II recens);
- Early latent form;
- Secondary recurrent syphilis;
- Secondary recurrent;
- Late hidden form;
- Tertiary syphilis;
- Fetal syphilis;
- Early congenital syphilis;
- Late congenital syphilis;
- Latent congenital syphilis;
- Visceral syphilis;
Symptoms of syphilis
Symptoms of primary syphilis
With acquired syphilis, the average duration of the incubation period is about 30 days (less often 15-20 days or several months).
причиной более длительного скрытого периода является прием после заражения бледной трепонемой незначительных доз медикаментозных препаратов, ингибирующих возбудителя. Note: the cause of a longer latent period is the intake after infection of a pale treponema with insignificant doses of drugs that inhibit the pathogen.
The first sign of primary syphilis is the emergence of solid chancre (at the site of infection). As a rule, this formation is localized in the genitals, in the anus, as well as in other areas of the skin and mucous membranes. In particular, it can be found in the oral cavity, on the cervix, in women on the nipples or on the fingers. This can be a single or multiple formation (bipolar chancres).
Hard chancre is a painless round-shaped erosion or superficial ulcer with smooth, gently sloping edges to the center, surrounded by healthy surface tissue. Its color can vary from bright red to grayish-yellow (the color of spoiled fat). Most often, a solid chancre has a smooth shiny surface, under which an exudate infected with a huge amount of treponema accumulates.
However, in open areas of the body, exudate can sometimes shrink and form crusts. At the base of a hard chancre, there is a seal that resembles ear cartilage (a densely elastic infiltrate). Thanks to him, this formation and got its name.
On average, the diameter of a neoplasm is 1 cm, but in clinical practice one can find dwarf chancre the size of a pinhead or giant chancre reaching 3-4 cm in diameter.
With uncomplicated course, spontaneous healing of a hard chancre occurs (after 1-10 weeks).
Very often, patients infected with treponema pallidum, because of painlessness, simply do not notice the primary subjective symptoms of syphilis. However, the slit-like chancre, which is localized at the bottom of the radial crease of the anus, is characterized by marked pain (due to the fact that he is constantly injured during defecation). Also, strong pain causes chancre-felon (a consequence of a mixed infection), which is formed on the nail phalanx of the index finger. If the patient has a complicated course of hard chancre (phagedenism, gangrene, phimosis, or paraphimosis), moderate pain is observed.
5-7 days after the appearance of the first syphilitic trait, the regional lymph nodes that appear in the path of the lymphatic drainage increase. In primary syphilis, regional lymphadenitis is characterized by an almost painless and uneven increase in some lymph nodes.
This period can last from six to eight weeks. One and a half weeks before its end, specific polyadenitis develops (most subcutaneous lymph nodes increase). Patients develop headache, fever, malaise and muscle aches. This symptom is a sign of mass spread of the pathogen. Some individuals infected with pallidum may develop neurotic disorders or depressive states.
Symptoms of secondary syphilis
The secondary period of syphilis without treatment lasts approximately 2 years. During this time, exacerbations may alternate several times in a wave-like manner with latent phases with a complete absence of symptoms.
The first rash (papules or roseola) often occur with residual phenomena of chancre and scleradenitis. After 1-2 months, they pass away without a trace, and a period of early latent syphilis begins. After a few weeks (months) comes a wave of generalized rash (secondary syphilis), which lasts about 1-3 months.
As a rule, over time, the duration of latent periods increases, the elements of the rash become larger and are arranged in groups, and the number of lesions decreases. Most often they can be found on the oral mucosa or in the crotch area.
For the secondary recurrent syphilis is characterized by the occurrence of wide warts, as well as hair loss and leucoderma (a violation of skin pigmentation). Sometimes on the patient's body can be found pustular syphilides, which do not cause any subjective disorders, and soon disappear by themselves (without treatment).
Despite the fact that during this period, purely skin symptoms are observed, pale treponema that has disseminated all tissues and organs can cause various forms of meningitis, liver pathologies (icteric or anicteric hepatitis), lipoid nephrosis or other kidney diseases, syphilitic gastritis , uveitis, as well as various lesions of bones and joints. Along with these, there are serious violations of the nervous system (stupefaction, paresis and epileptic seizures, as well as cerebral phenomena).
при проведении своевременного противосифилитического лечения ранние поражения нервной системы полностью устраняются. Note: with timely antisyphilitic treatment, early lesions of the nervous system are completely eliminated.
Symptoms of tertiary syphilis
Tertiary syphilis is characterized by a long latent course. It can appear after 3-4 years (with no treatment at all, or with insufficient treatment). Most often, this form of pathology can be found in patients suffering from chronic alcoholism, tuberculosis or other infections.
During this period, a small amount of dense infiltrates are found on the skin and mucous membranes of the patient, localized in the subcutaneous tissue or in the deeper tissues. After some time, they disintegrate, and in their place there are painless ulcers, which scar only in a few months or years. It should be noted that such syphilides are not accompanied by subjective disorders and do not violate the general condition of the patient. They contain very little pathogen, and therefore, they are practically non-contagious.
Symptoms of visceral syphilis
In visceral lesions, almost all the organs of the patient suffer, but most often the cardiovascular system. Often, patients complain of shortness of breath and persistent chest pain. In syphilitic aortitis, mitral and aortic valve insufficiency develops, and the ascending aorta is compacted.
Another early symptom of visceral syphilis is a lesion of the organs of the digestive tract, occurring in violation of the liver.
At the beginning of the secondary period, patients develop kidney disease. In this case, benign proteinuria, glomerulonephritis or specific lipoid nephrosis is most often observed.
On the part of the respiratory system, bronchopneumonia, dry bronchitis or interstitial pneumonia can be diagnosed.
With the development of late syphilis of the bones, patients are diagnosed with periostitis, osteoperiostitis, osteomyelitis of the flat and tubular bones, as well as syphilitic synovitis and osteoarthritis.
Symptoms of late neurosyphilis
After 10-15 years from the onset of the disease in patients revealed latent meningitis (very stable in anti-syphilitic therapy). In late diffuse meningovascular syphilis, on the background of pronounced symptoms of meningitis, there is a lesion of blood vessels, in which the cranial nerves are often involved, sensitivity is disturbed, and gummas of the brain or spinal cord (soft tumors characteristic of the tertiary stage of syphilis) and other neurological disorders are detected.
To date, congenital syphilis is quite a rare pathology. It occurs as a result of intrauterine infection of the fetus, which most often can occur when the mother is diagnosed with an early stage of syphilis. Sometimes congenital syphilis is asymptomatic, but at the same time, in clinical practice, there are cases when the fetus is detected white pneumonia, damage to the liver, tubular bones and endocrine glands. Often this condition in the VI-VII month of pregnancy leads to fetal death. Miscarriage may also occur at a later date or the birth of a sick child.
Inborn syphilis proceeds at an early age (up to 2 years). A child is born with flabby, wrinkled skin of a dirty-yellow color, he is diagnosed with specific pneumonia, dystrophy phenomena and syphilitic pemphigus (the appearance of bubbles with serous contents on the palms and soles). Early congenital syphilis occurs on the background of skin lesions, pathologies of the respiratory tract, central nervous system and organs of vision.
Late congenital syphilis is diagnosed in children 4-5 years old. At this time, a few rashes appear on the skin and mucous membranes of the child, as well as lesions of the internal organs and osteosclerosis.
Often, patients with congenital syphilis lack the xiphoid process of the sternum, the length of the little finger is much shorter than normal (“infantile little finger”), a “gothic” (high) palate is found, and dystrophy of the skull (buttock-like skull) and thickening of the sternal end of the right clavicle can be observed.
Diagnosis of syphilis
Diagnosis of syphilis includes a visual inspection of the patient, collection of epidemiological history, as well as laboratory research methods.
In laboratory practice, several methods are used to detect syphilis:
- – самый распространенный и наиболее доступный способ обнаружения возбудителя заболевания. Serological method - the most common and most affordable way to detect the causative agent of the disease. This method involves the identification of immunoglobulins, which produces the immune system of a person with syphilis. The Wasserman reaction, or, as it is called, the reaction of binding a compliment, is based on the fact that the patient's serum forms a complex with an antigen, which adsorbs the compliment.
- – это быстрый тест, который также основан на иммунологической реакции антитело-антиген. Micropreparation is a quick test that is also based on the antibody-antigen immunological response.
- . Immunofluorescence reaction (RIF) . This is the most accurate method that is used in laboratory practice to detect latent syphilis. As a rule, it is used in difficult and atypical cases, as well as in the diagnosis of late syphilis.
The main method of treating syphilis is antibacterial therapy. Currently, as before, penicillin-type antibiotics are used (short and prolonged penicillins or durant penicillin medications). In the event that this type of treatment is ineffective, or the patient has an individual intolerance to this group of drugs, he is prescribed drugs of the reserve group (macrolides, fluoroquinolones, azithromycins, tetracyclines, streptomycin, etc.). It should be noted that at the early stage of syphilis the antibacterial treatment is most effective and leads to complete recovery.
In the course of treatment, the attending physician may adjust his scheme, as well as, if necessary, prescribe a repeated course of antibiotic therapy.
An important criterion for curing the patient is to conduct control serological reactions.
In parallel with the antibacterial patient is assigned immunostimulating therapy. Also, non-specific treatment is mandatory (vitamin therapy, injections of biogenic stimulants, pyrotherapy and ultraviolet radiation).
In the process of treatment, any sexual contact is prohibited, as this may lead to infection of the sexual partner or to re-infection of the patient.
если произошел незапланированный половой контакт без использования средств индивидуальной защиты (или с нарушением целостности презерватива в процессе полового акта), специалисты рекомендуют сделать профилактическую инъекцию, практически на 100% предотвращающую развитие сифилиса. Note: if unplanned sexual intercourse occurs without the use of personal protective equipment (or in violation of the integrity of the condom during sexual intercourse), experts recommend a preventive injection, which almost 100% prevents the development of syphilis.
After treatment, patients are required to be at the dispensary observation (for each form of syphilis there is a corresponding period, as defined by the instructions). Such methods provide precise control over the success of antisyphilitic therapy. Without fail, all sexual and domestic contacts of the patient must be identified, examined and sanitized in order to prevent the spread of infection among the population.
During the entire period of follow-up, patients undergoing syphilis are obliged to refrain from sexual intercourse, and they are also forbidden to be blood donors.
Общественными мерами профилактики принято считать:
- Ежегодную диспансеризацию населения (старше 14 лет) предусматривающую сдачу крови на РМП.
- Регулярное обследование на сифилис лиц, находящихся в группе риске (наркоманов, гомосексуалистов и проституток).
- Обследование беременных в целях профилактики врожденного сифилиса.
Беременным женщинам, которые ранее переболели сифилисом и уже сняты с учета, назначается дополнительное профилактическое лечение.
- Tertiary syphilis
- Secondary syphilis
- Primary syphilis: symptoms, treatment
- Syphilis in women: symptoms and signs